Hospitals enter uncharted territory on masking

This fall will mark the first virus season since COVID-19 emerged in which hospitals and health systems must independently determine when and how to implement universal masking, if at all. 

The CDC dropped its universal masking guideline in September 2022, saying that healthcare facilities in areas without high transmission can decide whether to require patients, visitors and staff to wear face coverings. This May, the agency further loosened mask guidelines in accordance with the public health emergency's end, putting masking decisions in the hands of hospital leaders, versus national health officials.

The updated guidance says healthcare facilities should take a risk-based approach that considers various factors when determining when to implement universal masking, including local virus transmission, the types of patients cared for and stakeholder input. Universal masking should still be used when a unit or facility is experiencing a COVID-19 outbreak. 

The hands-off approach from federal health officials means hospital and health system leaders nationwide are now strategizing on the best approach to masking this fall as COVID-19 admissions tick up and new variants emerge. The U.S. saw 12,613 new COVID-19 admissions in the week ending Aug. 12, marking a 21.6 percent jump from the week prior and the fourth consecutive week of significant increase, CDC data shows. 

At least three hospitals in New York state reinstated mask mandates this month amid an uptick in positive cases and staff out sick with the virus. Auburn (N.Y.) Community Hospital restored its universal mask mandate Aug. 19 only a month after officially ending the policy. This trend is not isolated to the East Coast. Oakland, Calif.-based Kaiser Permanente also reintroduced universal masking at Santa Rosa (Calif.) Medical Center and its affiliated medical buildings this week. 

Houston Methodist has not implemented universal masking, but still recommends it throughout its facilities and requires it for interactions with immunocompromised and highly at-risk patients. The organization is looking at numerous factors to inform decisions about universal masking, including data from its robust wastewater surveillance program, positivity rates for patients and employees, and COVID-19 variant activity. The system is also monitoring COVID-19 patient levels in the hospital and intensive care unit, along with the severity of these cases.

"If we saw a variant that showed increased virulence or a big shift in immune escape from immunity from prior infection and from immunization, those are all things we look at that would give us more reason to recommend universal masking," Ashley Drews, MD, system epidemiologist and medical director of infection prevention and control at Houston Methodist Hospital, told Becker's.

Conversations about masking's role in healthcare is not limited to this immediate fall. The industry as a whole is navigating what masking policies may look like coming virus seasons. Dr. Drews pointed to numerous studies, which found universal masking during COVID-19 was linked to a decrease in other respiratory viruses, including flu and respiratory syncytial virus. However, masks can also hinder the patient-provider experience or impede communication.

Dr. Drews said there are ongoing efforts among leaders across the Texas Medical Center, which includes Houston Methodist, to decide what parameters to set for universal masking in the future. She predicts masks won't disappear from healthcare for good but acknowledged that blanket mandates may not be necessary every fall and winter. Instead, healthcare organizations are likely to embrace a more situational approach that allows for nuanced and tailored responses. 

"We really want to be cautious and make sure that we're recommending it in the right place at the right time," Dr. Drews said. 


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